anemia Flashcards
anemia
not enough rbc
classified by morphology or etiology (hemorrhage, hemolytic, nutrition def, aplastic)
caused by decreased rbc production, blood loss, increased rbc destruction
causes of decreased rbc production
deficient nutrients: Fe, folate, b12
decreased erythropoietin: CKD
decreased Fe available: liver issues
blood loss
post sx - expected
chronic: bleeding duodenal ulcer, colorectal cancer, liver disease, gastritis, menstrual flow (may be asymp and just not feel great), hemorrhoids; more insidious (sneak up)
acute: acute trauma, ruptured aortic aneurism or other blood vessel, GI bleed (peptic ulcer or ulcerative colitis - maybe recheck this?); sudden onset, cardiac instability, no time for body to compensate
increased rbc destruction
hemolysis - sickle cell, meds, incompatible blood, trauma
anemia - decreased production of rbc
decreased hgb synthesis - Fe deficiency anemia
defective DNA synthesis (megaloblastic anemias): cobalamin (b12) def - can include pernicious anemia (autoimmune) and most common cause of b12 def; folate def
decreased # of rbc precursors (at red marrow): aplastic anemias, chronic disease (renal fail), meds (chemo)
megaloblastic
impaired DNA synthesis
b12 and folate def
macrocytic and abn -> fragile cell membrane and therefore easily destroyed
s of anemia
depend on how fast it happens and how low it goes
severe s result from not enough o2 to heart (fainting, chest pain, angina, heart attack, worsening CHF
pallor, fatigue, lethargy, malaise, depression, impaired cognition, impaired memory, reduced exercise tolerance, SOB, changed stool color, dizzy, hypoT, heart palpitations, tachy, impaired libido, impotence, insomnia, enlarged sleen, paleness, cold, insomnia, leg cramps, HA
mild s of anemia
asymp to mild s with activity
10-14
moderate s of anemia
more cardiopulmonary s, may occur at rest
6-10
severe s of anemia
many body systems involved, s at rest
<6
reasons for cm
decreased O2 to muscles causes weakness
decreased E production causes fatigue
blood is redistributed (away from periphery) causing pallor in nails, palms, face, conjunctiva
increase in CO causes tachy and palpitations
increased secretion of erythropoietin causes bone pain
cardiac muscle hypoxia causes angina/MI, HF
overall hypoxia causes dyspnea and tachypnea
Fe deficiency: causes
inadequate diet, gut abs, blood loss (menstruation) or hemolysis
Fe deficiency: cm
can be asymp if chronic, pallor of conjunctiva (should have demarcation in normal people, anemic lose this)
epithelial atrophy: glossitis (inflam of tongue, red, sore, smooth), chelitis (inflam of lips, angular = corner of mouth), brittle hair and nails (koilonychia -> spoon nails)
pica: pagophagia (ice)
Fe deficiency: morphology
micro and hypo
cobalamin b12 deficiency
IF secreted by parietal cells in gastric mucosa -> needed for b12 abs
no IF = pernicious anemia - autoimmune
history of bowel sx of malabs, strict vegans, OH abuse, gastrectomy
cobalamin b12 deficiency: cm
GI: n/v, anorexia, abd pain, glossitis, chelitis
B12 specific!! NM: weak, paresthesia (numb/tingle in hands and feet), reduced vibratory/position sense, ataxia (uncoord), impaired thought process
cobalamin b12 deficiency: morphology
macro-normo
folate deficiency: rf
typically not abs problem
decreased intake: diet def and OH abuse
increased need: preg
folate deficiency: cm
insidious, similar to b12
no neuro problems -> help differentiate
folate deficiency: morphology
macro-normo
aplastic
results in pancytopenia (plt, wbc, rbc)
rf: mostly ido, autoimmune possibly?
cm: s/s anemia (fatigue), s/s leukopenia (infection), s/s thombocytopenia (bleeding)
maybe look those up!
dx with bone marrow biopsy
morph: normo-normo just not enough
nursing problems with anemia
activity intolerance (HR increased, palpitations, SOB) and/or fatigue
altered nutrition: less than body req or malN r/t inadequate intake or abs
alpastic: risk for bleed, infection, fatigue
collab care for anemia
treat cause: malN (increase intake), OH abuse (stop), abs issues (megadosese b12 PO or parenteral injections)
if cause is due to blood loss find and treat source of bleed (scope, occult)
med supplement: vits and minerals (ferrous sulfate, b12, folate); erythropoiesis stim agents (epoetin alfa)
teach foods high in def
nc for Fe
oral best: inexpensive and convenient, used to be 3-4/day now 1 ok
best abs as ferrous sulfate in duodenum (avoid enteric coated or XL), in acid so 1 hr prior to meal (can take with food first few weeks for GI SE - n), undiluted liquid can stain teeth (straw), dextran can be IV and IM (use z-track bc stain skin), can turn stools black -> not melena or blood (which would be malodorous, sticky and tacky) just colored by Fe and expected finding so teach!
other SE: heartburn, c!, d
IV dextran has risk of fatal anaphylaxis so start slow and be reaty
nc for b12
PO/IM/SQ/intranasal
IM preferred if severe def or neuro S
PO and IM similar effects if 1) some IF is present (so not pernicious) and 2) megadoses are given (really low abs - 1-4%)
take for life (pernicious)
nc for folate
PO
no SE
nc for erythropoietin
synthetic, esp common with renal disease and cancer
often given with Fe
IV/SQ 3/wk
SE: lots, weigh advant/disadvant, discontinue when hgb >10 (black box! = CV problems)
other nc
monitor labs, for s of hypoxemia, VS and o2
assess neuro (need b12)
o2 therapy, provide rest, keep warm (no heating pads if risk of paresthesia), blood trasF if severe enough (PRBCs)
foods high in Fe
liver, eggs, dried fruits, legumes, potatoes, dark green leafy, whole grain/enriched bread/cereals
give with vit C
foods high in b12
only in animal products (issues with strict vegans!)
red meats (liver), enriched grain products, milk and dairy, fish, eggs
foods high in folate
green leafy, legumes, whole grain, OJ, nuts
polycythemia
abnormal increase in serum hgb, hct, rbcs
polycythemia classified
relative: low plasma V/dehyd -> false high hct
primary: aka vera, genetic (at some point in life), not preventable, chronic (need ongoing eval and support)
secondary: COPD (most common, compensatory to tissue hypoxia), also high altitude
polycythemia: cm
increase in blood viscosity and volume
htn -> HA, decreased [], ruddy face, possible cyanosis of lips, nails, mucous membranes
complications of decrease BV = DVT, hemorrhage, angina, cerebral insuff and TIAs, stroke! (all due to decreased perfusion to brain and heart)
hypermetabolic bc increase in tissue viscosity and BV: night sweats and weight reduction
increase in rbc, H+H: pruritus exacerbated by hot water, pain in fingers and toes
polycythemia collab care
tm directed at @ decreasing blood volume and viscosity
phlebotomy (300-500 mL/every other day initially and then every few months), goal is to keep hct <42 F and 45 M
hydration
anticoags (decrease plt)
avoid immobility (clotting!)
antihistamine for pruritus -> diphenhydramine
